a family in the making

IVF

Of course, my wait is longer than two weeks because my clinic schedules pregnancy tests like a million days after transfer. At my old clinic, I had to wait 9 days for a beta. Not bad. I don’t remember feeling particularly tortured during that time. But now? Forget it. This wait feels endless.

I’m not going to test early. I do not want a seat on that roller coaster. I’ve seen too many negative pregnancy tests in my time. I don’t ever want to look at one, ever again. The beta shall remain the Final And Only Word on the matter.

I promised myself I wouldn’t start analyzing symptoms. For those of you who don’t know, everyone who does IVF or a frozen embryo transfer takes progesterone. Fun fact about progesterone: it mimics pregnancy symptoms. So there’s really no way to tell if you’re feeling pregnancy or progesterone. Which means analyzing symptoms is useless. However, a few days ago I started feeling nauseous. I fooled myself into thinking this was a legit sign. Since I wasn’t feeling it up to that point, it couldn’t be the progesterone, right?

Yeah, well, it’s not the progesterone, but it is something that has nothing to do with a pregnancy. I realized this morning that I started feeling nauseous at the exact same time I switched out my calcium brand. And calcium often makes me super sick to my stomach. So yeah, boo. I’m annoyed that I let myself fall into that trap.

There’s been good news in the last two weeks, though: one of our embryos made it to freeze! Huzzah! Anyone who knows my history knows that a cycle yielding 3 decent-quality embryos to transfer and one to freeze is HUGE for us. We will never have a freezer full of blastocysts like some of you lucky bloggers out there, but I am so incredibly grateful for one. We also have an embryo leftover from our first cycle, which means we have two frozen embryos total, all ready for another transfer if needed. But I really hope we don’t need it. I just heard from Braverman’s office that we have to get the full panel of immune testing done again before we can start another transfer. Those tests take six weeks to come back. This means we likely wouldn’t be able to do another transfer until January as our clinic closes for several weeks in December. Mother effer.

I’m just cranktastic today, there’s no getting around it. I’m tired of this wait. And sick of infertility in general. Like, I am so over it. I’m having a grand old time throwing a pity party for myself. I’d invite you guys, but you don’t want to come. It would probably be the lamest party you ever attended.

Today we transferred three day-3 embryos. I was really hoping for a day-5 transfer, but our little cellular bundles had other ideas. In order for my doctor to OK a day-5 transfer, I needed to have at least four 8-cell, grade-A embryos on day three. As of this morning we had two grade-A embryos, two grade-B embryos, and four others that were pretty fragmented or lagging behind.

I was semi-upset when I got the news that we’d be transferring today. In my head, getting to a day-5 transfer meant that my embryos were good quality. I felt misled by Dr. Braverman — after all, he promised me my embryos would be better quality this time around. What a cad! However, I just looked back at my day-3 report from IVF #1, and I had fewer decent embryos at that point than I did this morning, and we did a day-5 transfer anyway. So it seems that my new clinic is just more conservative with day 5 transfers. And you know what? I’m ok with that. I did not want to end up with nothing to transfer. No thanks.

The morning did not go smoothly. Tim wasn’t allowed into the OR area. The acupuncturist accidentally needled my left calf so hard that the entire muscle cramped up. The embryologist felt the need to tell me, multiple times, that just because two of my embryos were grade A did not mean that this cycle was going to work. Um, WTF? I finally said to her, “Look, I know that grade-A embryos guarantee nothing. This is my 3rd cycle. I’m just looking for some hope here.” Then the doctor was an hour late to my procedure. I had to pee so bad that my whole body was sweating. And when it was all over, the doc did not bother saying “goodbye” or “good luck” before he left the procedure room. Again, WTF?

Needless to say, I was on the edge of tears all morning. I tried listening to my meditations and all that biz, but none of it was really helping. The clinic is just awful, and unfortunately we have to use them because they are the only one in our area who works with outside doctors. The one bright spot was the nurse in the transfer room. She was awesome and totally kept the morning from careening off into The Bad Place Of No Return.

The actual transfer itself went off without a hitch — super fast, no weird catheter malfunctions, no embryos stuck in the tube, etc.. And now I have three embryos back where they belong, which is really all that matters in the end — not what day they arrived there.

So without further ado, meet our three beautiful babes. We transferred both grade-As and 1 grade-B. The rest will continue to grow, and we’ll find out their fate on Wednesday. Say “Hi,” kids!

When we picked Lettie up from the babysitter I showed her this picture.

“These are embryos,” I told her.

She looked mildly interested, so I asked, “Which one is your favorite?”

She immediately pointed to the chap on the bottom right.

Ooooh, I thought, maybe that one is The One.

Then she said, “Do we eat embryos?”

Aw, my little cannibal. Sprinkling embryos on her cereal.

Anyway, I’m feeling pretty good right now. Maybe not the zen-master self I was in my last post (ok, not at all), but still pretty decent. I carried the picture of our three babes with me everywhere today. I propped it on the couch and the embryos watched some football. They saw Pope Francis perform his historic mass on the Ben Franklin Parkway. I leaned them up against a trivet and there they stayed as we ate our dinner.

And really, I can’t help but think today is a fortuitous day. There’s a supermoon lunar eclipse tonight. The pope was cruising around my city, kissing babies and spreading his holiness everywhere. And, perhaps most unbelievable of all, the Eagles won.

For the past two weeks, I’ve been preparing my body with blood thinners, steroids and intralipids. There is a constellation of hematomas on my abdomen, like a map of our progress, a connect-the-dots path to our baby. Right before each shot, Tim and I hug. Then we send up a silent prayer to that spirit we know we are meant to meet. I don’t know what Tim says, but mine goes a little something like this: I love you. I’m open to receive you. Please come home.

In three days, all nine of our embryos will be defrosted. They will grow and divide in their mysterious way, and if all goes well, we’ll transfer two blastocysts on Tuesday.

Five months of preparation have come down to this one day. The trips to New York, the surgery, the immune testing, the supplements, the new doctors, the shots, the procedures, the blood work, the renewed hope—all lead to Tuesday.

Am I ready for it?

Yes.

If it works, I feel prepared to navigate the challenges of pregnancy after infertility and loss. I’m not saying it will be easy, but I believe I can do it without losing my sanity. If it doesn’t work, well, of course I’ll be crushed, but I will be ok. This is one thing I now know without a doubt: I will always be ok. I will hurt, sometimes so much that I won’t want to open my eyes in the morning, but I will keep going. I will heal.

And so, one way or another, this epic quest is finally coming to a head. I’ve searched far and wide to find the answers I needed. I’ve prepped my body. I’ve prepped my mind. I truly believe I’m giving this baby the best possible chance to make its way to us.

All that’s left to do is let go. To let what is meant to be, be. There is so much sweetness in that, and so much peace.

Hey, dudes. It’s been busy ’round these parts. Since my Dr. Braverman update, I went on vacation, work turned into Crazytown and I lost my friend to cancer. And, oh yeah, I did a stim cycle. Retrieval was almost two weeks ago at this point.

I’ve been meaning to update you guys on the cycle for ages, so here’s the breakdown.

What we did differently this time vs. last time

I was on a much lower dose of stims. You might recall that for my last IVF I was on the atomic bomb dosage of meds, so I was initially very worried about this decrease.

The doctor added Clomid to the Menopur and Follistim cocktail.

He also threw human growth hormone into the mix. (Yep, just like A-Rod.)

I did a double trigger. So instead of just HCG, I also injected myself with Lupron as well at trigger time.

I took my Dr. Braverman supplements throughout the cycle.

I worked with a fertility coach and she helped me change my entire headspace. Although I had a few relapses, I made it through the cycle with minimal anxiety. I’ll try to write more about the work we’re doing together soon. She’s awesome.

Instead of doing a fresh transfer, we froze everything on day 1. The embryos will later be thawed and grow to day 3 or 5 before being transferred.

How it turned out

I stimmed relatively fast — only 8.5 days

They retrieved 11 eggs. My first cycle they retrieved 10, and my second cycle they retrieved 8.

9 out of the 11 fertilized with traditional IVF! My first cycle 6 fertilized via traditional IVF, and my second cycle only 3 fertilized using ICSI (insert sad face here). So, HOT DAMN, 9 is pretty amazing for my bod. Dr. Braverman promised me that my embryos would be better quality now that my endometriosis is no longer hanging around, and I’m hoping the high fertilization rate means he’s right.

I believe

Since the embryos were frozen so early, we’ll have to wait until they thaw and grow to really know if they’re good quality. I believe in them, though. And I wasn’t sure I’d ever be able to say this, but: I’m beginning to believe in my body again, too.

So after my last post, I was feeling good. I had a plan. I was going to follow that plan, but I didn’t feel attached to the outcome. I felt like our child would come to us in whatever way he or she was meant to.

But what ever goes according to plan? Nothing, you say? That’s right. Nothing.

Warning: this might get long. And boring. Long and boring, yay!

This week we had our two second opinion consults. First up was CCRM. We spoke with Dr. Surrey and he was quite lovely. He had some interesting suggestions. One was that Tim get a next-level sperm test, the name of which escapes me now. Then he suggested I do a double trigger shot. He was thinking that the reason I had half as many mature eggs as follicles both cycles was because they weren’t responding properly to the trigger. He also does not consider someone DOR if they have normal FSH, AMH and antral follicle count. Finally, he said that I might as well transfer our frozen embryo at my current clinic before coming out to Colorado, and send him a thank you note if it works. We liked him. I think CCRM is a great clinic. I think they have amazing labs. Other than the labs, though, I didn’t feel like they had much more to offer us than our current clinic. And the multiple trips to Colorado alone would put us in a bad financial place, not to mention the out-of-network costs for the actual treatment. Case closed.

The next day we spoke with Dr. Braverman. He is a reproductive immunologist. This is a very new field, like so new there are only a couple of these doctors in the country. I first heard about him through my friend over at Spirit Baby Come Home. She has had a lot — way too many — miscarriages. She worked with Dr. Braverman and is now a few weeks away from giving birth. As soon as I heard of him I thought, Hmmm, that guy sounds interesting.

One of his main areas of research is endometriosis, particularly “silent endometriosis,” which is where you have the condition, but experience no symptoms. This piqued my interest because a close relative had this exact thing. She was diagnosed with unexplained infertility and had multiple IVF failures. They accidentally discovered that she had endometriosis during a surgery for something else. They removed it and then her next IVF worked. I’ve asked both of the doctors at each of the clinics I’ve been to if I should be concerned about endometriosis based on my family history. They both said that, no, I shouldn’t be worried. Even if I had endometriosis, the way to work around it is IVF.

Braverman completely disagrees with my doctors’ assessment. Through his reasearch he’s learned that endometriosis negatively impacts egg quality, often making it look like a patient has DOR, when in fact they don’t. He also says that Antiphospholipid Antibody Syndrome typically goes hand in hand with endometriosis.

With every mishap that happened these last few months — miscarrying the genetically normal embryo, getting diagnosed with a blood clotting condition — I started to wonder if I should contact him. But he is a recurrent miscarriage specialist and I’ve “only” had two, so I felt weird about that. Plus, I was comfortable at my clinic (I really do love them!). And finally, Braverman is beyond expensive. So I never pulled the trigger. I kept thinking about him, though, and wondering. Then after that last failed IVF and DOR diagnosis, I was like, ok, let me at least talk to the guy.

So I did. I had read a bunch of his articles before we spoke to him, so I was not surprised in the least when five seconds into the phone conversation he was like, BOOM, I think you have endometriosis. He said my family history, combined with my elevated anticardiolipins, combined with my diminished ovarian response, points strongly towards that diagnosis.

Even if what he was saying was true, the fact remained that we couldn’t afford to get treatment with him without sacrificing every penny we had and then some.

But then he told us that he would collaborate with a doctor about 45 minutes from us. This is huge. That means I could be under his care and still in-network with my insurance. Then his financial person got on the phone and said that if I needed surgery to remove endometriosis, the hospital they use is in our network. Meaning the surgery would be fully covered, too. This is even huger. I figured he would be recommending surgery, but I knew there was no way in hell we could swing out-of-network surgery. But it turns out that the only out-of-network things we’d have to pay for would be his initial testing and consulting fees.

Uh, so all of a sudden this doctor that I thought was totally out of reach just became a real possibility. It felt like the Universe had tipped its hat to me and said, “Here you go, wish granted.”

So we’re doing it. We figure the only thing we have to lose is time. The soonest we’d be able to do an IVF going this route would be September. We were just about to start a cycle at our current place in two weeks. That means we would be done with that cycle and, if needed, a frozen transfer and potentially be onto adoption by September. Now everything will get pushed back by several months.

But it feels like we would be doing that next cycle at our clinic just to do it. Which is kind of a yucky feeling. Don’t get me wrong, I don’t think Dr. Braverman is a miracle worker, at least not for everyone, but I do think that immunology is really the only avenue we haven’t explored yet. And, provided that he actually finds an issue, I think we have a better chance with him than our current doctor. How much better, I have no idea. It’s still nowhere near a sure thing, or even on the right side of the odds.

Then there’s always a risk that we do all the immune testing and get the surgery, and he finds absolutely nothing. I think in that case I would feel pretty stupid that my hunch led me nowhere.

In the end of the day, there is no right answer. But I do think it’s worth giving Braverman a shot.

In the meantime we plan to continue researching and saving for adoption. We’re going to try and do as much of the adoption leg work as we can so that if this hail-mary IVF doesn’t work we can jump right into it.

I’m not going to lie, these last few weeks have been rough. Really rough. In some ways, this failed IVF cycle hit me even harder than my last miscarriage. I know that might seem strange, but after our last loss, I still had so much hope. I knew IVF worked for us, and it seemed like maybe it was just a matter of time before we got lucky again. But let’s just say the last cycle and its accompanying diagnosis of DOR was a rude awakening. I’m not saying IVF can’t work for us, but it won’t be easy. Tim and I had to think hard about if we really wanted to fight this uphill battle to have another biological child. Because that’s what it is from here on out–a decidedly uphill battle.

So I did a lot of crying, a lot of feeling sorry for myself and, for lack of a less cheesy term, a lot of soul searching. Tim and I had several long, difficult talks. In the end, here’s what we decided.

There’s a limit to how much my body can deal with–I’m talking about the hormones, the poking and prodding, the minor surgeries, etc. I’m almost at my limit.

There’s a limit to how much our family can handle–the stress of endless appointments, injection timing, days off of work and in general putting our life on hold for treatments. We are almost at that limit.

There’s a limit to how much Tim and I can cope with the emotional roller coaster of hope and sadness, hope and sadness. We are almost at that limit.

We have a deep longing to parent another child. We will do almost anything to get there except ruin our marriage, destroy our financial future or negatively impact our relationship with the child that we already have. Do we have a deep longing to give birth to another child that looks just like Lettie? Nope. We want to parent. We want to share our love for life with a child. We want Lettie to have a sibling. These are the things that matter to us.

To that end, here’s our plan.

Because it is covered by insurance, we will do one more IVF cycle with our current doctor, likely in June. To prepare for that I’m taking DHEA and CoQ10 (both supposed to help with DOR). I’ve always read that you need to take these things for at least three months to make a difference, but my doctor thinks it’s still worth taking in the short term. She says three months is what’s been studied, so that’s why everyone says three months. Less than three hasn’t been studied yet, but that doesn’t mean it won’t help. There will be a new protocol this time, called micro-flare. It’s basically the last-ditch protocol for ailing ovaries. Birth control is typically used, but because of my blood clotting issue, my doctor says no birth control for me ever again. So we’ll do estrogen priming instead. Unless something crazy awesome happens (you never know), that’s likely it for us for fresh IVF cycles.

We will keep our phone consults with CCRM and Dr. Braverman next week. We’ve decided not to pursue CCRM beyond that call, but they might say something interesting that we can take back to our doctor. We may or may not end up traveling to NY to see Dr. Braverman for immune testing, depending on the cost with out of network insurance. We have decided that we will ultimately not pursue treatment with him, but I would still like to know if I have any immune issues (other than the one I already know about), should we decide to continue trying on our own or use donor eggs in the future.

If the fresh IVF in June doesn’t work, we will transfer our one remaining frozen blastocyst.

After that? We are all in for adoption. It’s time for a new chapter. We need to move on, and move forward.

We went to our first adoption support group this week. It was kind of great and kind of terrifying. It really put into perspective how long the process takes, and how much of yourself you need to put into it. It has just as much potential for heartbreak as infertility, but hopefully, at the end there will be another child. It’s not a sure bet–nothing is–but it’s as close as you can get in this world.

So here we are.

Still sad from all that has come to pass, yet steadfastly hopeful for the future, we find ourselves preparing for a whole new journey.